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‘Small things in a great way’: Smiles Across Montana

Jan. 1, 2020
This mobile dental hygiene clinic in Montana shows everything that hygienists can do for communities in need.

If you go to the Smiles Across Montana Facebook page and scroll down, you will find a quote by Martin Luther King Jr.: “If I cannot do great things, I can do small things in a great way.” Crystal Spring, BSDH, RDH, LAP, and Cara Reck, BS, RDH, LAP, may think they are doing a small thing, but as a fellow Montana dental hygienist, I know they are doing a great thing!

Those of you who enjoy reading RDH magazine and are familiar with the Sunstar/RDH Award of Distinction may remember the names of Crystal Spring and Smiles Across Montana. Crystal was presented with the 2019 Award of Distinction this past July at RDH Under One Roof in Dallas, Texas, for the magnitude of change being made for the residents of Montana. Crystal Spring and Cara Reck formed Smiles Across Montana (SAM) in January 2018 with the mission “to bring preventive dental treatment to communities in Montana who have limited access to care.” Since its formation, they have brought care to 26 different facilities, which include Head Start programs and nursing homes, and to the children on Montana’s Native American reservations. Most of these programs did not receive basic preventive dental care in the past due to their isolated locations.

Montana is a huge state, and very rural. This is one of the reasons that a Montana dental hygienist can apply for a limited access permit (LAP) to help accommodate those who have difficulty receiving oral care. Crystal and Cara both have these permits, which enable them to perform basic dental hygiene in board-approved facilities. They also have dentists who accompany them to the school-based programs so they can practice under supervision. 

The story of SAM

For those of you who are unfamiliar, here is what Montana has done to increase access to care: “During the 2003 Legislative Session, Senate Bill I 90 was passed. This allows for public health supervision of a dental hygienist who has additional licensure called the limited access permit (LAP). This law allows a Montana licensed dental hygienist to provide dental hygiene preventive services without the prior authorization or presence of a licensed dentist in a designated public setting. To work under ‘public health supervision,’ a dental hygienist must obtain a limited access permit from the Board of Dentistry.”¹ A LAP can be used in a wide variety of settings, including federally qualified health centers, migrant health-care facilities, nursing homes, group homes, and more.2

When asking the ladies of SAM what inspired them to start the nonprofit, Crystal talks about her brother, Carter, a Special Olympics athlete, who is a big reason why she is so passionate about public health. Crystal started working with Special Smiles, a program through the Special Olympics that does dental screenings for the athletes and helps them find a dental home. Carter is intellectually delayed and is on Medicaid, which fueled Crystal’s passion to help those who need someone to advocate for their care. 

Cara and Crystal both recognize the challenges that come with having a mobile dental unit, but have found support not only from the dental community, but also from people who value what they bring. They both feel that they have been provided more support than opposition. Cara is also a cancer survivor, something that informs her empathetic approach to patient care.

There are a few other dental professionals serving the community through SAM. Cara comes from a family of servicepeople, and her father is one of the four dentists who accompany the hygienists when providing care in school-based programs. Dr. Stetson, Cara’s father, is interning with SAM as he transitions from military service in the United States Air Force back into civilian life. Dr. Hayes, another dentist, reached out to SAM after hearing about the work they did on the Northern Cheyenne Reservation in Montana. Dr. Lawhorn worked with the Special Olympics for eight years and has a heart for giving back to the communities of Montana. Dr. Aleagha was the first dentist whom Cara and Crystal worked with in the school programs, and as a pediatric dentist she has always had a passion for giving back to rural communities. Each of these dental professionals has an internal drive to make a bigger difference for the residents of Montana.

Where SAM is headed

In the future, Crystal seesSAM training more registered dental hygienists to work in school-based clinics, and encouraging other hygienists to take the leap in their states to provide care to those who need it most. When I asked Cara what she felt was a success for SAM, she replied, “Success is getting to help these communities get the dental care they deserve. Just because they live in rural Montana, and might be in a fifth-generation farming family who has to decide on fixing their swather (crop harvesting equipment) or taking a family member into town for a regular dental visit, does not mean they are not deserving of the care.”

Both entrepreneurial dental hygienists have been active in their states and both have served as president of the Montana Dental Hygiene Association (MDHA). Cara continues to serve as the public relations chairwoman for the MDHA, and feels that MDHA has paved the way for SAM to accomplish its successes to date. Crystal continues to serve Montana dental hygienists as the District X trustee to stay abreast of legislative changes in dental hygiene.

Last year, Montana passed legislation allowing dental hygienists to apply silver diamine fluoride (SDF) to patients. SAM is excited to be able to provide this additional care in the future. The final vote will be in a few months and SAM is hopeful that the Montana Board of Dentistry will continue to see the value that SDF has for the general public. “SDF could be a real alternative for families who have a loved one needing treatment, but an invasive procedure is not the best option for them financially or otherwise,” said Cara.

SAM’s purpose is to make sure children have a positive dental experience, especially those who do not have a dental home due to lack of dental insurance or any other reason. The founders of SAM feel there is no reason children can’t be seen in a comfortable and safe environment, while allowing parents the opportunity not to miss work while providing their children preventive dental care.

One of the projects that Crystal and Cara enjoy the most is the opportunity to mentor the Montana State University – Bozeman nursing students. They use this time to educate the nursing students on the benefits of good oral health.

All of us have an opportunity to pursue our passion and to seek out purpose. SAM is about bringing valuable dental service to those who would not receive quality oral care otherwise—a worthy purpose that comes from the passion of two Montana registered dental hygienists. #MontanaRDHProud 


1. Limited Access Permit – LAP. Montana Dental Hygienists’ Association website. http://www.montanadha.org/limited-access-permit-lap-2/

2. Harbrecht J. Securing your limited access permit (LAP). Montana Dental Hygienists’ Association website. http://www.montanadha.org/wp-content/uploads/LAP-web.pdf

Melissa Kjos-Peterson, RDH, CIHC, is a clinical dental hygienist and health and wellness coach living in the beautiful state of Montana.